Inhaled antibiotics in bronchiectasis: Inhaled antibiotics in bronchiectasis

Edmundo Rosales-Mayor; Victoria Alcaraz Serrano; Eva Polverino

Authors

Edmundo Rosales-Mayor CIBERES, IDIBAPS, Fundació Clínic, Pneumology Unit, Institut Clínic del Tòrax, Hospital Clínic de Barcelona, Spain
Victoria Alcaraz Serrano CIBERES, IDIBAPS, Fundació Clínic, Pneumology Unit, Institut Clínic del Tòrax, Hospital Clínic de Barcelona, Spain
Eva Polverino CIBERES, IDIBAPS, Fundació Clínic, Pneumology Unit, Institut Clínic del Tòrax, Hospital Clínic de Barcelona, Spain

Keywords:

Bronchiectasis, inhaled antibiotics, nebulizer

Abstract

The presence of chronic infections in patients with respiratory diseases has led to an increased interest in inhaled antibiotics. Their utility has been demonstrated in cystic fibrosis (CF) and extended their use to chronic obstructive pulmonary disease and non-CF bronchiectasis (BE). We have seen a development of new inhaled formulations and nebulizers in the last years. The main objective is to reduce the airway bacterial load, symptoms and the rate and severity of exacerbations. Actual BE guidelines recommend inhaled antibiotics when a patient has 3 or more exacerbations per year. Recent meta-analysis shows an overall benefit for BE patients with inhaled antibiotics. Nowadays, there are different nebulizer systems such as ultrasonic nebulization, "jet" nebulizer, and vibrating mesh system. In addition, there are several antibiotic formulations for nebulization and some dry powder formulations. We review the current evidence available for inhaled antibiotics in BE patients and the systems designed for the inhalation of antibiotics.

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Inhaled antibiotics in bronchiectasis